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Prevalence of alternative diagnoses in patients with suspected uncomplicated renal colic undergoing computed tomography: a prospective study

Published online by Cambridge University Press:  11 February 2015

Julie Pernet ,
Sandra Abergel ,
Jerome Parra ,
Amine Ayed ,
Jerome Bokobza ,
Raphaelle Renard-Penna ,
Isabelle Tostivint ,
Marc-Olivier Bitker ,
Bruno Riou  and
Yonathan Freund
Julie Pernet
Affiliation:
Emergency Department, Groupe Hospitalier Pitié-Salpêtriere, Assistance Publique – Hopitaux de Paris (APHP), Paris, France Université Pierre et Marie Curie Paris 6 (Paris Sorbonne University), Paris, France
Sandra Abergel
Affiliation:
Emergency Department, Groupe Hospitalier Pitié-Salpêtriere, Assistance Publique – Hopitaux de Paris (APHP), Paris, France
Jerome Parra
Affiliation:
Urology Department, Groupe Hospitalier Pitié-Salpêtriere, APHP, Paris, France
Amine Ayed
Affiliation:
Radiology Department, Groupe Hospitalier Pitié-Salpêtriere, APHP, Paris, France
Jerome Bokobza
Affiliation:
Emergency Department, Groupe Hospitalier Pitié-Salpêtriere, Assistance Publique – Hopitaux de Paris (APHP), Paris, France
Raphaelle Renard-Penna
Affiliation:
Radiology Department, Groupe Hospitalier Pitié-Salpêtriere, APHP, Paris, France
Isabelle Tostivint
Affiliation:
Nephrology Department, Groupe Hospitalier Pitié-Salpêtriere, APHP, Paris, France
Marc-Olivier Bitker
Affiliation:
Urology Department, Groupe Hospitalier Pitié-Salpêtriere, APHP, Paris, France Université Pierre et Marie Curie Paris 6 (Paris Sorbonne University), Paris, France
Bruno Riou
Affiliation:
Emergency Department, Groupe Hospitalier Pitié-Salpêtriere, Assistance Publique – Hopitaux de Paris (APHP), Paris, France Université Pierre et Marie Curie Paris 6 (Paris Sorbonne University), Paris, France
Yonathan Freund*
Affiliation:
Emergency Department, Groupe Hospitalier Pitié-Salpêtriere, Assistance Publique – Hopitaux de Paris (APHP), Paris, France Université Pierre et Marie Curie Paris 6 (Paris Sorbonne University), Paris, France
*
Correspondence to: Dr. Yonathan Freund, Hôpital Pitie-Salpetriere - Service d’Accueil des Urgences, 47-83 Boulevard de l’Hôpital, Paris 75013, France.

Abstract

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Objectives

Unenhanced computed tomography (CT) has become a standard imaging technique for uncomplicated renal colic in many countries. The appropriate timing of CT imaging has not been established, and guidelines recommend that this imaging be performed between 1 and 7 days of presentation. The primary objective of this study was to determine the prevalence of alternative diagnosis identified with low-dose unenhanced CT in the emergency department (ED) in patients with suspected uncomplicated renal colic.

Methods

This prospective single-centre study was carried out in a large university hospital ED. Over a 6-month period, all patients with clinically diagnosed renal colic and a plan to be discharged underwent low-dose unenhanced CT in the ED. Pregnant women, women of childbearing age not willing to have a pregnancy test, and patients who had already undergone diagnostic imaging were excluded. The primary outcome was the number and nature of the alternative diagnosis. Univariate analyses were performed to assess factors associated with the primary outcome.

Results

A total of 178 patients were screened, and 155 underwent CT in the ED. The mean age was 42.2 years; 69% were male. The diagnosis of uncomplicated renal colic was confirmed in 118 participants (76%); 27 (17%) had an inconclusive CT scan. Overall, 10 patients (6%; 95% confidence interval [CI] 3–10) had an alternative diagnosis, 5 of whom were subsequently hospitalized.

Conclusion

Low-dose unenhanced CT in the ED detects alternative diagnoses in 6% (95% CI 3–10) of patients with suspected uncomplicated renal colic, half of whom are subsequently hospitalized. Our prospective findings, which were similar to those reported in retrospective studies, are a potential argument for a systematic approach to ED imaging in suspected renal colic. Future research involving intervention and control groups would be helpful.

Résumé

Objectif

La tomodensitométrie (TDM) sans densification est devenue, dans de nombreux pays, une technique d’imagerie courante dans les cas de colique néphrétique sans complications. Toutefois, le moment propice pour faire passer cet examen n’est pas établi, et, d’après les lignes directrices, l’examen devrait être effectué entre le premier et le septième jour de la consultation. L’étude avait pour objectif principal de déterminer la prévalence d’autres diagnostics que celui de colique néphrétique sans complications, posés dans des cas présumés, à l’aide de la TDM sans densification à faible dose, au service des urgences (SU).

Méthode

II s’agit d’une étude prospective, unicentrique, qui a été menée dans un SU d’un important centre hospitalier universitaire. Sur une période de 6 mois, tous les patients chez qui un diagnostic clinique de colique néphrétique avait été pose et pour lesquels la sortie était prévue ont passé une TDM sans densification à faible dose au SU. Les femmes enceintes, celles en âge de procréer qui ne souhaitaient pas passer un test de grossesse et les patients qui avaient déjà subi des examens d’imagerie diagnostique ont été écartés. Le principal critère d’évaluation était le nombre et la nature des autres diagnostics posés. Des analyses unidimensionnelles ont permis d’évaluer des facteurs associés au principal critère d’évaluation.

Résultats

Au total, 178 patients ont été sélectionnés, et 155 ont subi une TDM au SU. L’âge moyen était de 42.2 ans, et 69% des malades étaient des hommes. Le diagnostic de colique néphrétique sans complications a été confirmé chez 118 participants (76%), tandis que l’examen s’est révélé non concluant chez 27 (17%) patients. Dans l’ensemble, d’autres diagnostics ont été posés chez 10 patients (6%; intervalle de confiance à 95% [IC] 3–10), dont 5 ont dû être hospitalisés plus tard.

Conclusions

La TDM sans densification à faible dose, effectuée au SU conduit à la pose d’autres diagnostics que celui de colique néphrétique sans complications dans 6% (IC à 95% 3–10) des cas présumés, et la moitié des patients concernés doit être hospitalisée plus tard. Les résultats de cette étude prospective, comparables à ceux d’études rétrospectives, offrent un argument possible en faveur de la réalisation systématique d’examens par imagerie au SU dans les cas présumés de colique néphré tique. II serait toutefois utile de mener d’autres études comportant cette fois des groupes témoins et des groupes expérimentaux.

Keywords

computed tomographyemergency departmentrenal colic
Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 1 , January 2015 , pp. 67 - 73
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

Footnotes

Presented to the 2013 French Society of Emergency Medicine Annual Assembly, June 2013, Paris, France, and the 2013 American College of Emergency Physician Research Forum, October 2013, Seattle, WA.

References

1.Westphalen, AC, Hsia, RY, Maselli, JH, et al. Radiological imaging of patients with suspected urinary tract stones: national trends, diagnoses, and predictors. Acad Emerg Med 2011;18:699–707, doi:10.1111/j.1553-2712.2011.01103.x.Google Scholar
2.Brown, J. Diagnostic and treatment patterns for renal colic in US emergency departments. bit Urol Nephrol 2006;38:87–92, doi:10.1007/s11255-005-3622-6.Google Scholar
3.Miller, OF, Rineer, SK, Reichard, SR, et al. Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain. Urology 1998;52:982–987, doi:10.1016/S0090-4295(98)00368-9.Google Scholar
4.Wang, J-H, Shen, S-H, Huang, S-S, Chang, C-Y. Prospective comparison ofunenhanced spiral computed tomographyand intravenous urography in the evaluation of acute renal colic. J Chin Med Assoc 2008;71:30–36, doi:10.1016/S1726-4901(08) 70069–8.Google Scholar
5.Sourtzis, S, Thibeau, JF, Damry, N, et al. Radiologic investigation of renal colic: unenhanced helical CT compared with excretory urography. AJR Am J Roentgenol 1999;172:1491–1494, doi:10.2214/ajr.172.6.10350278.Google Scholar
6.Worster, A, Preyra, I, Weaver, B, Haines, T. The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: a meta-analysis. Ann Emerg Med 2002;40:280–286, doi:10.1067/mem.2002.126170.CrossRefGoogle ScholarPubMed
7.Varma, G, Nair, N, Salim, A. Marickar YMF. Investigations for recognizing urinary stone. Urol Res 2009;37:349–352, doi:10.1007/s00240-009-0219-z.Google Scholar
8.Middleton, WD, Dodds, WJ, Lawson, TL, Foley, WD. Renal calculi: sensitivity for detection with US. Radiology 1988;167:239–244.Google Scholar
9.Coursey, CA, Casalino, DD, Remer, EM, et al. ACR Appropriateness Criteria® acute onset flank pain-suspicion of stone disease. Ultrasound Q 2012;28:227–233, doi:10.1097/ RUQ.0b013e3182625974.Google Scholar
10.Fulgham, PF, Assimos, DG, Pearle, MS, Preminger, GM. Clinical effectiveness protocols for imaging in the management of ureteral calculous disease: AUA Technology Assessment. JUrol 2012 Oct 18 [Epub ahead of print].Google Scholar
11.Turk, C, Knoll, T, Petrik, A, et al.. Urolithiasis. Available at: http://www.uroweb.org/gls/pdf/18_Urolithiasis.pdf (accessed February 2013).Google Scholar
12.El Khebir, M, Fougeras, O, Le Gall, C, etal. 2008 update of the 8th Consensus Development Conference of the Francophone Society of Medical Emergencies of 1999. The treatment of adult renal colic by the emergency services and in emergency rooms. Prog Urol 2009;19:462–473, doi:10.1016/j.purol.2009. 03.005..Google Scholar
13.Bultitude, M, Rees, J. Management of renal colic. BMJ 2012;345:e5499doi:10.1136/bmj.e5499.Google Scholar
14.Wright, PJ. Managing acute renal colic across the primary-secondary care interface: a pathway of care based on evidence and consensus. BMJ 2002;325:1408–1412, doi:10.1136/bmj. 325.7377.1408.Google Scholar
15.Lindqvist, K, Hellstrtim, M, Holmberg, G, et al. Immediate versus deferred radiological investigation after acute renal colic: a prospective randomized study. Scand J Urol Nephrol 2006;40:119–124, doi:10.1080/00365590600688203.Google Scholar
16.Kluner, C, Hein, PA, Gralla, O, et al. Does ultra-low-dose CT with a radiation dose equivalent to that of KUB suffice to detect renal and ureteral calculi? J Comput Assist Tomogr 2006;30:44–50, doi:10.1097/01.rct.0000191685.58838.ef.Google Scholar
17.Niemann, T, Kollmann, T, Bongartz, G. Diagnostic performance of low-dose CT for the detection of urolithiasis: a meta-analysis. AJR Am J Roentgenol 2008;191:396–401, doi: 10.2214/AJR.07.3414.CrossRefGoogle ScholarPubMed
18.Cullen, IM, Cafferty, F, Oon, SF, et al. Evaluation of suspected renal colic with noncontrast CT in the emergency department: a single institution study. J Endourol 2008;22:2441–2445, doi:10.1089/end.2008.0120.Google Scholar
19.Patatas, K, Panditaratne, N, Wah, TM, et al. Emergency department imaging protocol for suspected acute renal colic: re-evaluating our service. Br J Radiol 2012;85:1118–1122, doi: 10.1259/bjr/62994625.Google Scholar
20.Meria, P, Bensalah, K, Bringer, J-P, et al. Resultats d'une enquete de pratiques aupres des urologues francais con-cernant la prise en charge des calculs et de la lithiase urinaire en 2012. Prog Urol FMC 2012;22:F56–62, doi:10.1016/j. fpurol.2012.04.003.Google Scholar
21.Nadeem, M, Ather, MH, Jamshaid, A, et al. Rationale use of unenhanced multi-detector CT (CT KUB) in evaluation of suspected renal colic. Int J Surg 2012 Nov 13 [Epub ahead of print].Google Scholar
22.Jo, H, Buckley, BT. Assessment of referral patterns for CT KUB in a tertiary setting. JMed Imaging Radiat Oncol 2009;53:516–521, doi:10.1111/j.1754-9485.2009.02117.x.Google Scholar
23.Ahmad, NA, Ather, MH, Rees, J. Incidental diagnosis of diseases on un-enhanced helical computed tomography performed for ureteric colic. BMC Urol 2003;3:2doi: 10.1186/1471-2490-3-2.Google Scholar
24.Van Der Molen, AJ, Cowan, NC, Mueller-Lisse, UG, et al. CT urography: definition, indications and techniques. A guideline for clinical practice. Eur Radiol 2008;18:4–17, doi:10.1007/s00330-007-0792-x.CrossRefGoogle ScholarPubMed
25.Caoili, EM, Cohan, RH, Korobkin, M, et al.. Urinary tract abnormalities: initial experience with multi-detector row CT urography. Radiology 2002;222:353–360, doi:10.1148/radiol.2222010667.Google ScholarPubMed
26.Chowdhury, FU, Kotwal, S, Raghunathan, G, et al. Unenhanced multidetector CT (CT KUB) in the initial imaging of suspected acute renal colic: evaluating a new service. Clin Radiol 2007;62:970–977, doi:10.1016/j.crad.2007.04.016.Google Scholar
27.Katz, SI, Saluja, S, Brink, JA, Forman, HP. Radiation dose associated with unenhanced CT for suspected renal colic: impact of repetitive studies. AJR Am J Roentgenol 2006;186:1120–1124, doi:10.2214/AJR.04.1838.Google Scholar